Dr Tricia Kleidon1,2,3,4, Associate Professor Jessica Schults2,3,4,5, Ms Victoria Gibson1,2,4, Dr Derek Roebuck6, Dr Ruth Royle7, Professor Robert Ware7, Professor Joshua Byrnes2, Professor Amanda Ullman1,2,3,4
1Vascular Assessment and Management Service, Queensland Children's Hospital, Brisbane, Australia, 2The University of Queensland, Brisbane, Australia, 3Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Australia, 4Children’s Health Research Centre, Brisbane, Australia, 5Herston Infectious Diseases Institute, Brisbane, Australia, 6Department of Medical Imaging, Perth Children's Hospital, Perth, Australia, 7Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, , Nathan, Australia
Biography:
Tricia Kleidon is a Nurse Practitioner in Paediatric Vascular Assessment and Management at Queensland Children’s Hospital and clinician-researcher committed to ensuring children receive the right vascular access device, inserted and managed safely. Her PhD investigated strategies to improve first-time PIVC insertion success, informing implementation of a nurse-led vascular access service.
Abstract:
Background
Non-cuffed central venous catheter (nc-CVC) dislodgement is a common and serious complication in children with tunnelled or peripherally inserted nc-CVCs. Dislodgement can interrupt therapy, require catheter replacement, increase healthcare costs, and contribute to infection risk, including central line-associated bloodstream infection (CLABSI). Subcutaneous Anchor Securement Systems (SASS) may provide greater catheter stability than traditional sutureless securement devices (SSD). This study evaluated the effectiveness of SASS in reducing catheter dislodgement and related complications in paediatric patients.
Methods
Multicentre randomised controlled trial was conducted between June 2020 and July 2022 at two Australian quaternary paediatric hospitals. Patients aged neonate to 18 years requiring a tunnelled or peripherally inserted non-cuffed central venous catheter (nc-CVC) were randomised 1:1 to SASS or SSD, stratified by device type. The primary outcome was catheter dislodgement.
Of 310 randomised patients, 307 received a device (153 SASS, 154 SSD) and were included in the intention-to-treat analysis. Dislodgement occurred significantly less frequently with SASS than SSD (5.2% vs 22.7%; RR 0.23, 95% CI 0.11–0.48; P<0.001). Partial dislodgement accounted for most events (3.9% vs 21.4%; RR 0.18, 95% CI 0.08–0.42). Overall dwell complications were lower with SASS (24.2% vs 39.0%; RR 0.62, 95% CI 0.44–0.87), including fewer CLABSIs and local site infections. Although removal was more difficult with SASS, healthcare costs were lower (mean saving AU$36.60; 95% credible interval AU$4.73–69.85). Per-protocol findings were consistent.
SASS significantly reduced nc-CVC dislodgement and was associated with fewer catheter-related complications, including CLABSI and local infections. Improved catheter stability may represent an effective infection prevention strategy to reduce central line failure and avoid unnecessary catheter replacement.